Arrhythmias and conduction disturbances
Atrial fibrillation after beating heart surgery

https://doi.org/10.1016/S0002-9149(00)00829-8Get rights and content

Abstract

Postoperative atrial fibrillation (AF) is a frequent adverse event after coronary artery bypass grafting (CABG) and may negatively affect the early clinical outcome. We sought to investigate the risk factors, prevalence, and prognostic implications of postoperative AF in patients submitted to CABG without cardiopulmonary bypass (off-pump). The study population comprised 969 patients, 645 men (67%) and 324 women (33%) who had off-pump CABG at the Washington Hospital Center from January 1987 to May 1999. Preoperative AF patients were excluded (n = 15). Two hundred six patients (age 69 ± 10 years, 137 men [66%]) developed AF, whereas 763 patients (age 61 ± 12 years, 508 men [67%]) did not. Predictors of AF included age >75 years (odds ratio [OR] 3.0, 95% confidence interval [CI] 1.9 to 4.5; p <0.001), history of stroke (OR 2.1, CI 1.2 to 3.7; p = 0.007), postoperative pleural effusion requiring thoracentesis (OR 3.2, CI 1.0 to 9.4; p = 0.03), and postoperative pulmonary edema (OR 5.1, CI 1.2 to 21; p = 0.02). Minimally invasive direct CABG was associated with a lower incidence of AF (OR 0.4, CI 0.3 to 0.7; p <0.001). AF was associated with a prolonged postoperative hospital stay (9 ± 6 days AF vs 6 ± 5 days no AF, p <0.001). In-hospital mortality was significantly higher in AF patients (3% AF vs 1% no AF, p = 0.009). Patients with persistent AF had a higher postoperative in-hospital stroke rate than patients without persistent AF (9% vs 0.6%, p <0.001). AF after beating heart surgery is associated with a higher in-hospital morbidity, mortality, and prolonged hospital stay. A minimally invasive surgical approach (minimally invasive direct CABG) is associated with a lower risk of AF.

Section snippets

Patients

All patients (n = 12,364) who underwent CABG at the Washington Hospital Center between January 1987 and May 1999 were identified using the computerized database system of the Department of Cardiac Surgery. Of these, 993 (8%) underwent off-pump CABG. Patients with preoperative AF (n = 15) were excluded, as were patients who initially underwent operation off-pump and who had to be converted to a standard on-pump procedure (n = 9). Thus, our study population comprised 969 patients with normal

Results

During the study period, 206 of the 969 patients (21%) who underwent off-pump CABG developed postoperative AF. The mean AF rate throughout the study period remained constant throughout the period of study (0.22 ± 0.1). Baseline clinical and demographic characteristics are summarized in Table I. Patients who developed AF were more likely to be older and to have type 1 (insulin-dependent) diabetes, ejection fraction <34%, multivessel disease, or previous stroke than did patients without AF.

Discussion

AF is a common complication after open cardiac procedures and its incidence has been reported to vary between 3.1% and 30%,1, 2, 3, 7 compared with 1.8% in the general population.12, 13 Different mechanisms have been proposed to explain the high incidence of AF after cardiac surgery, including withdrawal of β blockers administered preoperatively14; structural changes in the heart such as those related to age, the effects of cardiopulmonary bypass, and cardioplegia, as well as the effects of

Acknowledgements

We are indebted to Ellen Shair for her editorial contribution to this manuscript.

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